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Still not enough

dmoonchildddmoonchild Posts: 383
edited 06/11/2012 - 8:25 AM in Pain Management
My pain medicine is still not enough. I started seeing my new PM Dr in July. We started at 30mg oxycodone 2 a day along with vicodin 7.5 4 a day ( with a muscle relaxer and lunesta). Each time Ive gone back (monthly) he has increased my breakthru meds. Oxycodone 5mg and then oxycodone 10mg 3 a day which Im on now. Its just not nearly enough. Last time I cried in his office. I HATE when I do that! I ve asked to have the oxycontin 3 times a day and he said no. He usually asks me what I want to do. I dont know whether to increase the OXycontin or breakthru meds. Any suggestions?
Does one ususally max out on the Oxy before going for the patch or methodone? Im also going to ask my other PM about a Spinal cord stimulator. I cant go thru another Epi Injection if they are all going to be like my last one. Im still suffering from that one.


  • If you can add in other therapies. There are a few that are allowed with oxycodone. This is under utilised. Look up cancer pain treatments and pain management.

    I add in to my regime and it makes a massive difference. I titrate all the doses (under supervison) which has meant I have stayed on a moderate dose of oxy and add in according to my pain levels before I increase the oxy.

    Paracetamol and ibubrofen are the 2 meds that you can add they both work by enhancing the opiate without increasing actual opiate dose.
    But you do need to be strict with dosing and careful not to take too many.

    Make sure you get professional advice but there is a way forward for you.

    Take care
  • Dmoon,
    I am a bit concerned when I read your posts. :S I am going to be honest with you here, and hope that you will take what I am saying with the good intent that it is being sent. :|
    Every post I have read about from you in regard to pain meds has been how they are never enough. :S I don't know what it is that you are hoping for, from pain management, but to think /hope to be painfree , with spinal problems is not realistic. :<
    You, honestly are on a good amount of meds, especially for someone who has not been through surgery, 110 mg of oxycodone a day, is alot of it. @) Adding another 40 mg dose of oxycontin is going to put you at a place that most of us have only been on after going through surgery and several months if not a year or more of recovery. #o
    I am worried for you, and about you and how you deal with pain, and hoping that there is not some other reason that the pain meds don't seem to work so well for you. :|
    I know from your previous posts that you have been on several strong pain meds, and none of those offered you any relief either. :??
    When you say your current dose is "not nearly enough", what do you mean by that? :?? What dose would be nearly enough? :?? What dose do you feel that you need to be on in order for you to have less pain? :??
    I am concerned that you are headed down a road that I don't think that you want to go down, and that you may be using the pain meds to cover other pain, rather than physical. =(( I am concerned about you becoming addicted to the pain meds. :|
    Most people on the same dosage of medications that you are currently taking would have at least a moderate amount of pain relief. Are you taking the pain meds exactly as directed by your doctor or do you adjust your dosage or timing of dosage on your own? :?? Do you take extra because you feel that more will give you "better" pain relief? :??
    You do realize that taking the breakthrough dose every time you are allowed to take it will make it not effective for those times when you are experiencing legitmate breakthrough pain? Leaving you with nothing to bring those extra high pain levels down to a tolerable level? /:)
    What else do you do to manage the pain, beside rely on the meds? What physical excercise are you doing to help improve your overall muscle strength? Are you in PT? What about using other modalities to help with the pain levels? :??
    I can't recall now if you have ever posted what exactly is supposed to be wrong with your back, so if you won't mind, please refresh my memory so that maybe I or someone else can make some other suggestions that might help you.
    As far as a scs goes, it just seems that you are rushing things a bit, most pm's won't even go there with a patient until they #1, have a specific problem that they know can not be addressed through surgery or PT or other means, and #2, that the pain meds are not a realistic , long term treatment option, and they are sure that there is nerve damage/nerve injury that will not recover on it's own, before offering that option. SCS will not help mechanical pain, it will help neuropathic pain, but only if it is truly neuropathic, and most neuropathic pain means that there is compression of a nerve root, nerve rootlet or injury of some sort that won't heal on it's own.
    Anyway, as I said, I hope that you take this in the spirit it is intended, and that is to help you.
    Take care,
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  • Thank you for the advice. I am not expecting to be pain free and often ask myself, how much pain relief can be expected from meds? I cry everyday because of the pain. I set my alarm clock at 5 am so I can take my oxycontin. I have to lay in bed for an hour for it to work before I can attempt to get out of bed. I take my meds exactly as prescribed. The pain makes me sweat, fell sick to my stomack and makes my heart hurt. I am still working. I have to get up and lay on the floor every 10 min. After working, I go home and all I can do is rest my back. I try to exercises but most days it hurts too much. Then the spasms start and I cant move. My Dr says no therapy now as I am currently getting EPI injections every 3 months or so. The last injection made me sick for 2 weeks. I was denied surgery by 3 Drs because there was too much damage. I have 3 herniated disks, stenosis and DDD.
  • I take ms contin 60 mg twice a day and rarely every 3 or 4 days take a percocet. Are you on a slow release medication? I found ms contin once a day not enough to cover the nighttime so then I was put on ms contin 30 mg twice day then my Dr. put me on ms contin every 6 hours but the pm Dr. said it's better to take 60mg twice a day. I think a slow release would be more helpful for you overnight so you wouldn't wake up in so much pain. Just imo. Most Drs don't want to give fast acting narcs. They usually give extended relief at a higher dose with a break through med. I hope you can find some relief. Take care . Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • I read your post and I was wondering how come you were denied surgery? The conditions you listed are operable, and I was curious as to how long have you been struggling with this pain? I had a TLIF and it was my second surgery, but unfortunately neither has worked for me. I'm on Fentanyl, Norco, and other meds to handle muscle spasms and nerve pain. And I still struggle with pain. I guess it's something I'll have to deal with and realize I probably won't be pain free. I really hope the doctors figure out a way to make you feel better and that you have a success outcome, whatever treatment you may have in the future.
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  • The 3 surgeons I went to said they were not willing to take a chance on paralyzing me. They there was far too much damage all thru my spine. My husband came with me for thoses appointmnets because I usually end up crying halfway thu and I need someone with me to listen to the Dr and the reason why they wont operate. I did get an appointment at a very good hospital with the top surgeon there. Im crossing my fingers he can help me.
  • I didn't realize that and I am sorry this has happened to you. I hope this next surgeon can give you some kind of option. Being a mom, I know how difficult it is to struggle with your pain and raise your children. Since I can't do much, my priority is taking care of my family and seeing that the household runs somewhat smoothly. I wish you and your family the very best.
  • Thanks for all of your suggestions and help. Im a little freightened by what sandi said. Am I becomming addicted to these meds? I have tried to be very careful and follow directions, make every appointment with my Dr. I do not get high whatsoever from these meds. They do make a huge difference but Im just not sure how much pain relief I can expect from meds alone. People that know me see me struggle with the pain and tell me to tell the Dr how much pain Im really in and not to sugar coat it. Im looking to get enough relief to 1)keep working 2) take care of my family..make dinner...give baths to the kids 3) not be so cranky and have to be in bed all weekend. I am asking too much?
  • Dmoonchild. Here's another possible explanation. I have neuropathic pain, coming from a damaged L5 nerve. Narcotic pain medication doesn't really help nerve pain. On an ordinary day, I take my Dilaudid ( a short-acting narcotic and the reason I take this is a whole other story)and it relieves most or all of my pain. If I am having a pain flare, the same dilaudid does nothing--it doesn't evenmake a dent in the pain. I truly believe (I have not tried this) that if I were to double or triple the dosage it would make no difference. My point is that nerve pain does not respond that great to narcotics. Maybe you've gone over all of this already and I didn't see it as I am going to finish this post and get ready for work. Ususally, drugs like Neurontin and Lyrica are used for nerve pain and they really help some people. But if like me, nerve pain is your problem, medical science is only now really figuring out how that all works and how it can be treated. So, it is possible that tons of narcotics wouldn't relieve your nerve pain but taking more would not be the answer and if its not helping, why take it?
  • I have come to the realization that no matter what I take (Fentanyl, Norco, Cymbablta, Zanaflex, etc.) that I will not be pain free. I will always have constant pain and I know that these meds I'm on will hopefully keep it in a bearable range. It's hard to accept that I can't perform multiple tasks in one day. For me it is, "I'll try to tackle this today, and try to get to the other tomorrow." It's a hard pill to swallow, especially if you are young, or in the prime of your life. There is no single cure for chronic pain. It's a condition that you have to manage, just like diabetes or heart disease.
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